Help! Losing my supply, trying everything, don't want to give up!

[petitpois]

I hope someone out there can help me. My baby just turned 4 months, and we're using more and more formula supplements, completely against what I want. I've been fully committed to breastfeeding and spent my maternity leave doing everything I could find to make it work, but now I feel like I might really be failing. In the last 5-6 weeks, I’ve gone from having enough milk to feed and satisfy the baby plus pump and store a little, to one formula bottle a day at first (after her 3m checkup where the doctor said to try to feed her more, she wasn’t gaining enough, so maybe I never made enough?)… it increased gradually until a couple of weeks ago, then quickly went up in the past week to over 50% formula. It happened so fast and in the middle of other changes (back to work, daycare glitches, etc), but I thought it would turn around after things calmed down and it hasn’t!

This is my first baby, and although I always planned on breastfeeding and didn’t prepare for anything else or for challenges, it has been pretty complicated from the beginning, due to both medical reasons and latch issues. I started out exclusively pumping and finger feeding (with the help of an IBCLC and a double electric pump) and got my supply up, eventually worked out the latch, and had a nice breastfeeding relationship for a few weeks in months 2-3, but it’s gotten really difficult again. The baby used to love nursing and still seems to when she’s relaxed and not too hungry, but there are way fewer circumstances where she will accept the breast, like the conditions have to be just right.

I’m taking lots of herbal supplements and homeopathy, pumping 3-4x/day (while I’m away from the baby), and of course nursing whenever she is willing, but that’s getting less and less often and becoming a real struggle except at night (usually). Now when she does nurse, it seems to be mainly for comfort, but she doesn’t even need it to go to sleep anymore (that changed only this week), and even in the middle of night I usually end up giving her a bottle (4oz) after she nurses and still wants more. Not only is my supply down, but I can tell that my let-down is slower (even when pumping I get almost nothing for the first 10min, when it used to be the highest) and the flow is slower (I never hear the baby gulping anymore). She often gets frustrated while nursing and starts crying, then refuses – sometimes she refuses to even try. Again, this was not happening 6 weeks ago, when she was willing to wait for the letdown. I even go at lunchtime to feed her, but half the time she refuses and I have to give her a bottle! It’s so demoralizing.

I used to get very full after 3-4hrs, painful after 5, but now I hardly even feel full enough after 5-6hrs. Also I have pumped the whole time, so I can see some reflection of my supply there: I used to easily pump 5oz in 20min, now I’m lucky to get 3-4oz in an hour. There is also a strange asymmetry to this: My right side used to produce about double of the left one (could pump around 4-5oz vs. 2-3oz, and it always felt more full and was bigger), and now it produces less than half and look smaller and never feels full no matter how long I go between pumping/feeding (although the baby seems to get milk when she nurses, it never seems to stimulate more production). So I think most of my supply problem comes from the drop in what the right side is producing, and the left side is ok for the weak producer but not the main source! However there is still a slower letdown and flow on both sides. What could be causing just one side (the productive one!) to stop producing? I wish I had noticed this aspect of it earlier, but at first all I knew was that there was less.

Here are what I think are the main problems, but I suspect I’m missing something important:

- A stressful period that coincided with (caused?) the reduced supply – this is why I didn’t panic at first, everyone told me it would come back as soon as things got settled. Right before going back to work (the baby was 10weeks old and still very dependent on soothing and being held), I found out the daycare we were ready to start used a sort of cry-it-out method for naps, and didn’t pick up babies much in general. I had to argue with my husband about it for a week or two, then scramble to find another solution, which also took a couple of weeks. That has now been resolved – she is in a small home daycare with 2 other babies, and I feel confident she is getting good care – but my supply has not come back!!! I go at midday to feed her at the nanny’s but she often refuses (I always pump afterward either way). 

- A nipple shield I can’t wean from. I know this can cause long-term supply problems, and I’ve tried to get rid of it, but I don’t think it’s the main problem because we were doing so well before.

- Supply is apparently not responding to herbs etc.

On the advice of a midwife, I’m going to ask for a thyroid check (when my doctor comes back from vacation, arg), but has anyone seen this kind of supply-loss pattern? What could be happening? Is there any hope? I feel like I’ve read and tried everything out there but there must be something I’m missing! I don't want to give up but I'm getting discouraged!

[rtjunker]

The best thing you can do to up your supply is have your LO nurse as often as possible. Her suckling will stimulate your breasts to produce more milk. When she seems finished nursing, switch sides again, or try to get her to suckle a little bit longer. Try to nurse more frequently as well. Pumping as often as possible will also help to tell your body to make more milk, though it's not as good as LO suckling. Also try to decrease the amount of formula you're giving LO, even just by a little bit at a time. The more you supplement, the less milk you will produce, kind of a vicious cycle.

Good luck. I hope you can figure this problem out. Also if you can talk to a Lactation Consultant, that may be helpful.

[BlueStateMama]

Quick thought - my DH noticed something when I nursed - my babies did great on my left side, less production on my right.  He pointed out it was my nursing position ( I used a Boppy)  I did fine cross chest and horrible when I tried to "flip" baby over and nurse on the right (pumping mimicked this.)  I started to nurse "normally" on the left and then slide the Boppy around so baby was football under my right arm to nurse on the right side - no "flipping"  (does that make sense?)  As always - check out Kellymom.com - lots of good info - and try talking to your local LLL leader (always found them more helpful then the hospital peeps)

[3girls1boy]

It sure does sound like you are having a stressful time and I would guess that is part of it.  It sounds like it is possible that your baby is starting to prefer the quick and easy flow of the bottle.  You might want to try having your caregivers feed your baby only from a cup (this is not really very difficult--use a small cup and just have the caregiver tip a swallow at a time into your baby's mouth and then wait for a swallow before tipping the cup to her mouth again.  At 4 months, you could even use a small spouted cup.) I wouldn't go with a cup with a no-spill valve though, that takes a very different sucking technique and I've also been told by a speech pathologist that if a child uses that type of cup for too long, it will cause speech difficulties.

Babies at this age also typically tend to get very distracted when nursing (they've suddenly begun to notice all sorts of other things going on in the world!), so choosing a quiet place to nurse can be helpful.  Some babies nurse better at this age when they are asleep, or almost so, so though it won't be so easy with having to go to work during the day, try to nurse as much as she is willing throughout the night.  Would it be helpful to pump until you have let-down and then latch her on?  Don't stress too much about the nipple shield--it's my understanding that the newer ones don't inhibit supply as much as the older types did.

You might also want to think about whether you want to start on some solid foods instead of offering formula.

(I've also found that fullness and the amount I could pump always dropped around the mid year point with my babies and you are certainly getting close to that.)

Hang in there, you are doing the best you possibly can.

Jeanne, mom to 4